How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.
Rates by insurance carrier
| Insurance Carrier | Facility/Professional | Modifier | Typical Low | Median | Typical High |
|---|---|---|---|---|---|
Aetna Setting Professional Modifier None Typical Low $263.03 Median $316.23 Typical High $316.23 | Professional | None | $263.03 | $316.23 | $316.23 |
Anthem BCBS Setting Facility Modifier None Typical Low $512.86 Median $660.69 Typical High $1,258.93 | Facility | None | $512.86 | $660.69 | $1,258.93 |
Anthem BCBS Setting Professional Modifier None Typical Low $239.88 Median $239.88 Typical High $245.47 | Professional | None | $239.88 | $239.88 | $245.47 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $23.99 Median $23.99 Typical High $26.30 | Professional | RR · Rental | $23.99 | $23.99 | $26.30 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $181.97 Median $181.97 Typical High $199.53 | Professional | UE · Used equipment | $181.97 | $181.97 | $199.53 |
Cigna Setting Facility Modifier None Typical Low $245.47 Median $245.47 Typical High $389.05 | Facility | None | $245.47 | $245.47 | $389.05 |
Cigna Setting Professional Modifier None Typical Low $177.83 Median $177.83 Typical High $245.47 | Professional | None | $177.83 | $177.83 | $245.47 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $204.17 Median $457.09 Typical High $602.56 | Professional | None | $204.17 | $457.09 | $602.56 |
Martin's Point Setting Professional Modifier None Typical Low $263.03 Median $316.23 Typical High $316.23 | Professional | None | $263.03 | $316.23 | $316.23 |
United Setting Facility Modifier None Typical Low $147.91 Median $147.91 Typical High $204.17 | Facility | None | $147.91 | $147.91 | $204.17 |
United Setting Professional Modifier None Typical Low $186.21 Median $263.03 Typical High $724.44 | Professional | None | $186.21 | $263.03 | $724.44 |
8 more rates with less common billing modifiers
A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.
| Insurance Carrier | Facility/Professional | Modifier | Typical Low | Median | Typical High |
|---|---|---|---|---|---|
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $131.83 Median $158.49 Typical High $158.49 | Professional | 52 · Reduced service | $131.83 | $158.49 | $158.49 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $53.70 Median $63.10 Typical High $63.10 | Professional | 53 · Discontinued | $53.70 | $63.10 | $63.10 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $39.81 Median $47.86 Typical High $47.86 | Professional | 55 · Aftercare only | $39.81 | $47.86 | $47.86 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $26.30 Median $31.62 Typical High $31.62 | Professional | 56 · Pre-op care only | $26.30 | $31.62 | $31.62 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $131.83 Median $158.49 Typical High $158.49 | Professional | 52 · Reduced service | $131.83 | $158.49 | $158.49 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $53.70 Median $63.10 Typical High $63.10 | Professional | 53 · Discontinued | $53.70 | $63.10 | $63.10 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $39.81 Median $47.86 Typical High $47.86 | Professional | 55 · Aftercare only | $39.81 | $47.86 | $47.86 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $26.30 Median $31.62 Typical High $31.62 | Professional | 56 · Pre-op care only | $26.30 | $31.62 | $31.62 |
Where Maine sits
The same service costs 2.9 times more in Montana than in Delaware. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.
Maine· 23rd of 51
$245
Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.